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Prognostic Indices Of Diabetic Foot Disease
Abstract
OBJECTIVE: To determine the prognostic indices and outline objective factors to be considered in management of diabetic foot disease.
METHOD: Forty-six diabetic feet in 38 patients were studied using a predetermined protocol of clinical and management indices. There were 24 males and 14 females giving a male:female ratio of 1.7:1. The ages ranged from 26 years to 74 years with a mean age of 52.8 years.
RESULTS: The venous filling time, Meggit-Wagner grading status, associated medical condition, eye signs, duration and type of diabetes mellitus were found to correlate with prognosis. Aggressive antibiotic treatment following aerobic and anaerobic culture, radical serial debridement, and frequent dressings after hypertonic saline soaks of the limbs resulted in healing of 31 out of 46 feet (67.4%) at a mean haling time of 2.4 months. Eight limbs had major amputation giving amputation rates of 17.4%. We recorded six mortalities out of the 38 patients (15.8%).
CONCLUSION: We conclude that diligent clinical assessment, prompt and aggressive antibiotic treatment, radical sequential debridement, and meticulous attention to wound dressing in a multidisciplinary setting would reduce rate of amputation and mortality in diabetic foot diseases. Where limb salvage is not possible, above knee amputation is the best option.
Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 84-89
METHOD: Forty-six diabetic feet in 38 patients were studied using a predetermined protocol of clinical and management indices. There were 24 males and 14 females giving a male:female ratio of 1.7:1. The ages ranged from 26 years to 74 years with a mean age of 52.8 years.
RESULTS: The venous filling time, Meggit-Wagner grading status, associated medical condition, eye signs, duration and type of diabetes mellitus were found to correlate with prognosis. Aggressive antibiotic treatment following aerobic and anaerobic culture, radical serial debridement, and frequent dressings after hypertonic saline soaks of the limbs resulted in healing of 31 out of 46 feet (67.4%) at a mean haling time of 2.4 months. Eight limbs had major amputation giving amputation rates of 17.4%. We recorded six mortalities out of the 38 patients (15.8%).
CONCLUSION: We conclude that diligent clinical assessment, prompt and aggressive antibiotic treatment, radical sequential debridement, and meticulous attention to wound dressing in a multidisciplinary setting would reduce rate of amputation and mortality in diabetic foot diseases. Where limb salvage is not possible, above knee amputation is the best option.
Nig Jnl Orthopaedics & Trauma Vol.2(2) 2003: 84-89
